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'Telehealth' - Where and how would it work best?

I

Iain King

Member
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24
So, where do people think technology could really make a difference to the lives of people with diabetes?

For those that haven't heard of Telehealth, it's basically equipment to monitor vital signs etc, and is used for a number of conditions.

My thoughts at present are that it would work best for:
- Enabling people to go home from hospital sooner
- Educating people who are newly diagnosed
- Educating people who are struggling with BG levels

But, as we all know, the NHS doesn't have all the answers! Especially not a manager like me, who has no clinical experience, and doesn't have diabetes!

Look forward to your thoughts. Something tells me this topic may well spark debate and make it on to the weekly email!
 
I'm afraid it wouldn't be much use to me.
I'd rather have blood glucose strips on prescription
 
I'd rather see more newly diagnosed kids kept in hospital for a week to learn (along with their parents) the basics - rather than being kicked out after 24 hours and left to the tender mercies of a diabetic nurse or other non-specialist.

If you want to see why, just look at some of the threads on here from parents of newly diagnosed children.
 
What a wonderful idea Iain, pretty soon we will be able to lay off all the doctors and nurses and just have managers and people answering telephones and reading scripts to diagnose conditions.

Absolutely brilliant
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Sid Bonkers said:
What a wonderful idea Iain, pretty soon we will be able to lay off all the doctors and nurses and just have managers and people answering telephones and reading scripts to diagnose conditions.

Absolutely brilliant
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Click to expand...

At least we'd cut public debt. :wink:
 
lionrampant said:
I'd rather see more newly diagnosed kids kept in hospital for a week to learn (along with their parents) the basics - rather than being kicked out after 24 hours and left to the tender mercies of a diabetic nurse or other non-specialist.

If you want to see why, just look at some of the threads on here from parents of newly diagnosed children.
Click to expand...

If you can point some of these threads out for me, I'll make sure they're passed on to my colleague.
 
Sid Bonkers said:
What a wonderful idea Iain, pretty soon we will be able to lay off all the doctors and nurses and just have managers and people answering telephones and reading scripts to diagnose conditions.

Absolutely brilliant
thumbsup.gif
Click to expand...

Hi Sid,

Like I said in the first post, I knew this may spark interest, postively or negatively; and I'm glad some people have commented already, as it means I can take those comments forward.

First of all, I would like to say that introducing Telehealth systems is not a means of reducing the amount of clinical staff that are employed. Rather they are a different way of working, which is imperative in the NHS if we are to continue to fund care for the population, which has an ever increasing demand; which owes to the ageing population; which owes to the NHS improving so much over recent years that people are living longer.
The NHS has had a boom in previous years, which has seen an increase in quality of care and quantity of staff. Telehealth systems are not there to remove the quantity of staff; but the reality is that the NHS has a finite amount of money, and especially during the economic turmoil we're currently facing, it has to work very differently (but no less effectively) to be able to make it through.

If I can move on to discuss Telehealth systems a little more... They are not necessarily monitored by a call centre, and this depends upon the model that is being used. However, if a model is developed whereby a call centre of non-clinicians is being used, they are under clinical supervision, with the parameters for the Telehealth system set by the clinician and patient in co-operation. Rest assured that there is still a massive amount of clinical involvement in the process.
In other models, the Telehealth system may well be monitored directly by clinical staff.
 
Hi Iain.

All very good stuff, if you believe that all we can do is deal with the effects when things go wrong.
The case study from Lothian was significant in that nobody seems to have dealt with the ladies problem, namely that her Diabetes was not well controlled ?

Did anybody not think that she obviously has a problem, so let's address the fundamental issue, get her blood glucose levels under control. A simple task using dietary and/or Insulin adjustment. But, no we are just shown what can be done if she falls etc. Using the proverbial, 'sledge hammer to crack a nut ?'

What is the point of all this ? All it seems to me to be is an advert for Tunstall, nothing of benefit to people with health care problems that isn't already out there in one form and another.

You have previously stated you work for a PCT. Well my son 'works' for many companies in his employment, he upgrades their computer systems and trains the employees, but he is actually employed by a different company altogether ? Can I ask if you are in any way connected to this Company, Tunstall ?
 
Hi Cugila,

First, let me apologise. The Tunstall link was simply an example, but since people seem to have a good grasp of what it is, I'm of course more than happy for moderators to take the link and reference to Tunstall away. (Delete this paragraph if indeed you do delete all references, as it will be null and void)

I do indeed work directly for a PCT. I am wary of course about coming across as a 'manager' that sparks debate from most people I meet - even my own family! I would however like people to see me as a 'normal' person, who is simply interested in delivering benefits to patients in the NHS within a personal capacity; regardless of my profession. That's why I'm here. I wanted to use the forum to speak to people that wouldn't neccessarily be consulted with as part of any work we do at the PCT. Again, for my personal experience, rather than with my PCT hat on - I'm simply genuinely interested.

Can you please provide me with some more information on the 'Lothian' case. I'm not sure if I've missed something obvious.

There is a possibility that, in the circumstances you're talking about in the Lothian case, Telehealth could have been of assistance, as an educative tool; alongside traditional health care. It has been shown to work within other specialities; for example COPD. I, of course, would be interested in hearing your views on how and why this may not be applicable to diabetes.
 
Hi Iain.

Thanks for clarifying things. We get a lot of companies trying to promoter their products and we do have to be careful.

Here is a 'clickable' link to the Case Study I mentioned.
http://www.tunstall.co.uk/assets/litera ... othian.pdf

I was unable to provide an extract as the document is security protected.
I have looked at the site and the other references (COPD) but they are all too vague to come to any considered opinion.

As I said before nobody appears to be looking at the prevention side of things. As you will see on this forum many members, myself included are all keeping tight control of BG levels which has benefited all of us immensely. It has a knock on effect as well. Personally. I now no longer take the 4 Glic and 6 Met per day, all because I made some simple adjustments to diet and took control.

The people who have the majority of the problems and complications in later life are the 'uncontrolled' Diabetics. So in my view, gadgets are not the answer here in relation to Diabetes. It is control, achieved through education, diet and close monitoring. You do not need outside organisations who are only in it for the profit.

The latter is what many PCT's are loathe to support. That is what we Diabetics want to see. Give us the tools to control, then see the NHS save money. Alter the NHS dietary advice about consuming carbohydrates !! They convert to glucose, just what a Diabetic with high BG levels needs ??

Nobody seems to be listening. There are numerous threads on here about people not being given simple things like meters and test strips. Sometimes if they get them they are told to test only once a week !! What is the point of that ?

Would you like to run your car without a speedometer, fuel gauge, oil and water gauges ?? That's basically what many are being asked to do only it's our bodies we are talking about.

Prevention is far cheaper than dealing with the complications.

Ken.
 
Edit: I've only just seen the link and we're not really talking about the same thing, but it is a use of telemedicine.


don't know if this is the same thing Gluconet, 'With the advances of mobile phones, various mobile-based diabetes surveillance systems were developed. In the GLUCONET, a project developed by France Telecom and Toulouse University hospital, patients send glucose measurement to doctors in the form of phone messages [3]. Logging data is time consuming and error-prone, particularly
when daily frequent measurements are required. Zou et al proposed a mobile station -Mobile Diabetes Management and Internetworking System (MDMIS) - in which data from glucose
meter is transmitted to mobile phone via Bluetooth [52]. The system was implemented using Sony Ericsson P800 and MediSense Optium glucose meter. '

Diagram and a bit more detail here( in French) but advice came from the diabetologist,. ie a specialist.
http://www.athos.asso.fr/IMG/pdf/pres-gluconet_montpellier_mr_perreal.pdf

This was a trial of the system with pump users.
http://www.sciencedirect.com/scienc...serid=10&md5=606f5f1bc103228baca5dfefdcfdd7f6
and there are links on the page.to a similar trials in Japan (don't know if it was the same system) with type 2s

I think it has potential to work well, but as an adjunct, not a substitute for face to face consultations.
 
Hi Ken,

Thanks for the Case Study. I see what you mean now, and I absolutely agree! Ok, so there's a time and place where that method can work (if someone is totally reluctant to involve themselves and change their lifestyle, but doesn't mind wearing a falls detector), but as you've said, for almost 100% of cases, people would rather take control of the condition to reduce the hypers and hypos. I certainly would rather control it, if I had it.

What has happened with Telehealth for COPD is that those with quite bad cases were going into the hospital as emergency admissions, which could have been prevented if the right education was there, and people took control of their own condition. With the help of Telehealth, this is what happens, and a reduction in emergency admissions is seen. Not only does this help to put money back in to the NHS (either to improve other services or to re-invest in Telehealth), but the most important thing was that the patients were reassured that a clinician was reviewing the results, and working with a preventative ethos; which as I understand it, has actually been a relatively alien concept to the NHS until recent years.

I think it could work the same for Diabetes; but that's why I'm here. I'd rather get it right first time than spend taxpayers' money on something that simply doesn't work.
As you've mentioned, quite simply, keeping tight control of BG levels can have an immensely positive health impact, and that's what I'd also like to do, with Telehealth.
With Telehealth, the person using it is able to learn from the readings, straight after being diagnosed, meaning they can ensure control of their BG levels from the outset.
Obviously this isn't all the person would be provided with, and they wouldn't keep the Telehealth equipment for the rest of their life (possibly around 2-3 months - I don't know). It serves as an additional educative device.
I completely agree that we need more control, education, diet advice and close monitoring. This is where Telehealth can improve things. It may be that people are provided with a Telehealth system following their DESMOND/DAFNE course. Do you think that would be useful?

I can't comment on test strips, as it's not personally my area, but I can and can't see the sense in that. Once someone has gained control over their condition, they may only need to test once a week. I think that's where we want to get to ideally, through preventative educational systems. I do agree though that there is a long way to go, but we have to start somewhere.

I also can't comment on diet, but perhaps (especially with the younger generation generally being more techno-savvy), a forum such as this should be something that is provided within an education pack. From what I've seen on here, there is no standard way of approaching diabetes, and that needs to be recognised and embraced!

I like your analogy about a car and it's guages - I'll keep that in mind! (Though again, I think this is where Telehealth could be useful)

As a side note to the above... My previous car didn't have an oil guage (more and more modern cars won't), so I didn't know when the car was up to temperature, and consequently, when I was able to use full revs. I took it upon myself to learn what the car needed before I could use full revs, and from that, have learned to take better care of all of my cars therein.

I really appreciate all the comments thus far, and I'm glad I decided to post.
 
Phoenix,

Exactly the sort of thing the NHS will move to, eventually. And I agree, it's never a substitute to face-to-face education, but rather an additional educational device, and monitoring where care could be provided closer to home.
 
Hi Iain.

Thanks again.

There are some further comments I will make in reponse but as I'm off to the Pub for a while it will have to wait. I will be sober when I get back.... :D

Ken
 
Pub on a Friday afternoon? Sounds brilliant! Perhaps I could convince my boss that in order to involve many more people to discuss this, I should join you? :lol:
 
I'm too tired to go looking through all my old posts. Have a look back and if you can find a thread by a guy called Martin Buchanan - his son was diagnosed and the adventure that followed was worrying. Or the woman whose daughter was diagnosed at Easter and had to wait months to be taught how to count carbs (er, little vital especially on MDI, no?). Sorry I can't cite specifics threads, too tired :shock:.

The point is these aren't the exceptions as far as I can tell (although I should say that I've never heard of these problems north of the border - it seems NHS Scotland has a handle on this, even if they did close the diabetic ward at Yorkhill two months after I got out*).

*many moons ago in the mid 90s I should point out. :wink: Thankfully the Scottish system has always treated me well. Perhaps that's why I get so angry when I see these people suffering on here.
 
lionrampant said:
I'm too tired to go looking through all my old posts. Have a look back and if you can find a thread by a guy called Martin Buchanan - his son was diagnosed and the adventure that followed was worrying. Or the woman whose daughter was diagnosed at Easter and had to wait months to be taught how to count carbs (er, little vital especially on MDI, no?). Sorry I can't cite specifics threads, too tired :shock:.

The point is these aren't the exceptions as far as I can tell (although I should say that I've never heard of these problems north of the border - it seems NHS Scotland has a handle on this, even if they did close the diabetic ward at Yorkhill two months after I got out*).

*many moons ago in the mid 90s I should point out. :wink: Thankfully the Scottish system has always treated me well. Perhaps that's why I get so angry when I see these people suffering on here.
Click to expand...

I'll definitely take a look, and pass it onto my colleague, too. I don't personally know the ins and outs of diabetes as a whole service here, as that's my colleague's area. I purely deal with Telehealth - with regards to Diabetes, anyway.

Again, I'd see Telehealth being extremely beneficial to this cohort of patients though. They can have the education within the hospital, and then leave with the Telehealth equipment, which they use for say 2-3 months, to hopefully help them learn more about their condition.

If I'm on the wrong track though, please someone put me on the right one.
 
Perhaps it would also be encouraging to newly diagnosed diabetics to be encouraged to join self help forums such as this one so they know they are not alone and can read about others experiences.
 
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